Hospital Patient Flow and NEST. Damian Miners, Principal Policy Analyst, SRF February 2013
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1 Hospital Patient Flow and NEST Damian Miners, Principal Policy Analyst, SRF February 2013
2 Patient Flow & NEST Many strategies to assist with the flow of patients through NSW Hospitals National Emergency Access Targets (NEAT) National Elective Surgery Targets (NEST) Patient Flow Systems and Patient Flow Portal Hospital in the Home Community packages ComPacks
3 Patient Flow & NEST What affects a Hospital s Patient Flow? Increasing presentations to ED s across NSW
4 ED Attendances across all NSW Hospitals Long period of no real growth followed by a 24% increase from Source = NSW Health Annual Report:: Total ED Attendances by Year to
5 Patient Flow & NEST What affects a Hospital s Patient Flow? Increased ED admissions Planned & Unplanned surgery Winter sicker patient s
6 Patient Flow & NEST What affects a Hospital s Patient Flow? Ageing population Longer length s of admissions Discharge rates
7 Patient Flow & NEST Knock on effect Admissions & overcrowding in ED Ambulance delays Delaying Medical and Surgical admissions Surging open beds
8 Patient Flow & NEST Poor health outcomes for patients who stay longer than required in both Inpatient ward beds Emergency Department
9 Patient Flow & NEST Organisational Strategy Utilise Predictive Tool via Patient Flow Portal
10 Predictive Planning Patient Flow Portal Capacity Demand planning 14 days ahead Identifies bed capacity deficits Earlier escalation Earlier intervention
11 Predictive Planning The Data: We know there is actually little variation in: ED presentations ED admissions Discharges The predictive tool collates Patients coming into the hospital Patients exiting Capacity to fit demand Uses Historical data Current ED status Expected EDO, DOSA, Surgical and Medical booked Direct admissions Projected discharges / EDT Data is used to inform short and long term capacity planning: Calculate tipping points in the short and long term Analyse daily demand for each ward area deliver a plan for required discharges each day. Analyse demand over the long term (e.g. identifying frequent outliers does this service require extra capacity?) Mange predicted events medical term change / public holidays / events
12 Patient Flow Portal
13 Predictive Planning Actions Discuss predictive plan with Hospital execs Awareness and shape of the organisation over the next 14 days Review surgical bookings in advance Bed containment Surge capacity when needed Review future staffing requirements
14 Patient Flow & NEST How does Planned Surgery Influence patient flow?
15 Predictability of Emergency Trends Emergency Surgery is predictable emergency vs. non-emergency Surgical admissions Planned Surgery is not! emergency other Total separations for surgical procedures 7,000 6,000 5,000 4,000 3,000 2,000 1, /31/2007 3/10/2008 5/19/2008 7/28/ /06/ /15/2008 2/23/2009 5/04/2009 7/13/2009 9/21/ /30/2009 2/08/2010 4/19/2010 6/28/2010
16 Predictability of Emergency Trends ED emergency attendances by week of year - NSW Presentations are predictable Emergency attendances 50,000 45,000 40,000 35,000 30,000 25, ED emergency admissions by week of year ,500 Admissions are predictable 9,000 8,500 8,000 7,500 7,000 6,500 6,000 5,500 5, Emergency admissions
17 Booked Variation Is booked variation tipping the facility over the edge Variation in booked activity can be a driver for consistent capacity short falls Identification of trends Develop action plans to manage problematic variation
18 Patient Flow Portal
19 Predictive Planning Planned Surgery Allocate dates for surgery in PAS at least 2 to 4 weeks in advance. Be aware and understand your day to day variations in overnight bookings Reduce variation where possible
20 Variation Management Variation in practice affects LOS, errors, complaints, admission rates, readmission rates, off stretcher time, emergency access performance, diagnostic capacity, delays in consults, staff satisfaction. Questions to answer: What can we control? How differently do we have to do things? What time frames are we looking at? Flattening the variation within a coordinated system leads to better outcomes.
21 Predictive Planning Planned Surgery Gain access to the Patient Flow Portal - review the Predictive Tool be informed! Surgery Models of care: - Extended Day Only / 23 Hour - High Volume Short Stay Surgery (HVSSS) - Emergency Surgery Models
22 Patient Flow Patient Flow is everyone s responsibility
23 Patient Flow Questions?
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